In a report published by Daragmeh et al in Rheumatology, investigators discovered that the use of exogenous sex hormones increased the likelihood of remission among female patients with rheumatoid arthritis, especially in perimenopausal or early postmenopausal patients. The analysis included nearly 4,500 patients pooled from several phase III trials in which patients were being treated with tocilizumab and/or conventional synthetic disease-modifying antirheumatic drugs. Researchers found that patients who were premenopausal were more likely to experience remission than perimenopausal or postmenopausal patients and that patients using hormone therapy or oral contraception in addition to their antirheumatic agents were more likely to achieve remission. The study authors highlighted, “It is particularly noteworthy that the negative association between the perimenopausal state and remission was reversed by the concomitant use of exogenous sex hormones, which approximately doubled the likelihood of achieving remission in perimenopausal women.”
In a companion press release on the study findings from the University of South Australia, senior author Michael D. Wiese, PhD, stated, “The peak age of onset of rheumatoid arthritis among females is 45 to 55 years, corresponding with a drop in estrogen when women typically enter a perimenopausal period, where their periods become irregular. Furthermore, at the onset of menopause, there is an increase in pro-inflammatory proteins.” The study authors noted that the interplay between rheumatoid arthritis remissions and the use of exogenous sex hormones is an area where “further research is required to confirm and identify the drivers for this observation and how it interacts with menopausal status.”